Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study.
J Laryngol Otol. 2016 Apr;130(4):413
Authors: Mills R
PMID: 26991879 [PubMed - as supplied by publisher]
Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study.
J Laryngol Otol. 2016 Apr;130(4):412
Authors: Lou ZC
PMID: 26991878 [PubMed - as supplied by publisher]
Active middle-ear implant fixation in an unusual place: clinical and audiological outcomes.
J Laryngol Otol. 2016 Apr;130(4):404-407
Authors: Polanski JF, Soares AD, Dos Santos ZM, Mendonça Cruz OL
Abstract
OBJECTIVE: The Vibrant Soundbridge is an active middle-ear implant for hearing rehabilitation that is usually placed in the long process of the incus or round window. This study reports on the unusual implant attachment to the short process of the incus in a patient with ear malformation, and describes their audiological and clinical outcomes.
METHODS: Case report and literature review.
RESULTS: Audiological evaluation with the Vibrant Soundbridge implant showed a pure tone average of 31 dB. The speech test, at 65 dB HL, revealed correct recognition of 92 per cent of disyllabic words. The Glasgow Hearing Aid Benefit Profile showed high levels of satisfaction, hearing aid use and benefit.
CONCLUSION: Fixation of the Vibrant Soundbridge implant on the short process of the incus is a feasible option, with good clinical and audiological outcomes. Coupling the floating mass transducer to the short process of the incus is a good surgical option, especially when the long process and the oval or round window are inaccessible.
PMID: 26991877 [PubMed - as supplied by publisher]
A murine model of subglottic granulation.
J Laryngol Otol. 2016 Apr;130(4):380-387
Authors: Ghosh A, Leahy KP, Singhal S, Einhorn E, Howlett P, Cohen NA, Mirza N
Abstract
OBJECTIVE: This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes.
METHODS: Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation.
RESULTS: Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury.
CONCLUSION: Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.
PMID: 26991876 [PubMed - as supplied by publisher]
Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis.
J Laryngol Otol. 2016 Apr;130(4):373-379
Authors: Asik MB, Karasimav O, Birkent H, Merati AL, Gerek M, Yildiz Y
Abstract
OBJECTIVES: Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients.
METHODS: The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry.
RESULTS: All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively).
CONCLUSION: Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.
PMID: 26991875 [PubMed - as supplied by publisher]
Comparison of Carina active middle-ear implant with conventional hearing aids for mixed hearing loss.
J Laryngol Otol. 2016 Apr;130(4):340-343
Authors: Savaş VA, Gündüz B, Karamert R, Cevizci R, Düzlü M, Tutar H, Bayazit YA
Abstract
OBJECTIVE: To compare the auditory outcomes of Carina middle-ear implants with those of conventional hearing aids in patients with moderate-to-severe mixed hearing loss.
METHODS: The study comprised nine patients (six males, three females) who underwent middle-ear implantation with Carina fully implantable active middle-ear implants to treat bilateral moderate-to-severe mixed hearing loss. The patients initially used conventional hearing aids and subsequently received the Carina implants. The hearing thresholds with implants and hearing aids were compared.
RESULTS: There were no significant differences between: the pre-operative and post-operative air and bone conduction thresholds (p > 0.05), the thresholds with hearing aids and Carina implants (p > 0.05), or the pre-operative (mean, 72.8 ± 19 per cent) and post-operative (mean, 69.9 ± 24 per cent) speech discrimination scores (p > 0.05). One of the patients suffered total sensorineural hearing loss three months following implantation despite an initial 38 dB functional gain. All except one patient showed clinical improvements after implantation according to quality of life questionnaire (Glasgow Benefit Inventory) scores.
CONCLUSION: Acceptance of Carina implants is better than with conventional hearing aids in patients with mixed hearing loss, although both yield similar hearing amplification. Cosmetic reasons appear to be critical for patient acceptance.
PMID: 26991874 [PubMed - as supplied by publisher]
New anticoagulants, a new book and old gags.
J Laryngol Otol. 2016 Apr;130(4):323
Authors: Youngs R, Fisher E, Hussain M, Fishman J
PMID: 26991873 [PubMed - as supplied by publisher]
Editorial.
J Laryngol Otol. 2016 Jan;130 Suppl 1:S1
Authors: Harvey RJ
PMID: 26988865 [PubMed - in process]
Surgical treatment of superior laryngeal neuralgia: A case report and review of the literature.
Ear Nose Throat J. 2016 Mar;95(3):E1-E7
Authors: Salzman R, Gabrhelík T, Stárek I
Abstract
Superior laryngeal (SL) neuralgia is paroxysmal pain above the thyrohyoid membrane. We present a case of SL neuralgia that was resistant to conservative treatment and eventually required surgical intervention. The patient was a 39-year-old woman with a 5-year history of debilitating pain above the thyroid cartilage. After having undergone different imaging scans with negative results, she tried various treatments (e.g., antibiotics, analgesics, stellate ganglion block, radiofrequency SL neurotomy, and stereotactic radiosurgery), all of which were ineffective. Finally, she underwent bilateral surgical SL neurotomy. Postoperatively, she immediately noticed a significant alleviation of her pain. Her postoperative course was completely uneventful, as she experienced no dysphagia or dysphonia, even transiently. One month later, she no longer required regular painkillers, and at 14 months, she remained essentially pain-free. While medical management remains the treatment of choice for SL neuralgia, we recommend that refractory cases be treated initially with a neural block with local anesthesia. Patients who do not respond are candidates for surgery. We consider selective peripheral SL neurotomy to be safe and effective when performed by experienced hands. We also discuss the difficulties of managing SL neuralgia.
PMID: 26991222 [PubMed - as supplied by publisher]
A Five-Year Analysis of Airway Foreign Body Management: Toward a Better Understanding of Negative Bronchoscopies.
Ann Otol Rhinol Laryngol. 2016 Mar 17;
Authors: Friedman EM, Anthony B
Abstract
OBJECTIVE: To identify characteristics in patients who undergo positive and negative bronchoscopy for a suspected airway foreign body (AFB).
METHODS: Review medical records between 2008 and 2012.
RESULTS: There were 145 patients who went to the operating room with the pre-bronchoscopy diagnosis of suspected AFB during the study period. There was an overall negative bronchoscopy rate of an average of 37%, with an annual range between 21% and 50%. The findings of history or suspicion of choking, asymmetric breath sounds, and wheezing were statistically more common in patients with an AFB. Chest roentograms (CXR) had a sensitivity and specificity of 62% and 57%. Twenty patients had a chest computed tomography (CT) scan, and 100% were clinically significant. Four CT scans were diagnostic of an AFB, and 16 patients avoided bronchoscopy after negative CT.
CONCLUSIONS: In current clinical practice, it is difficult to identify patients with an AFB without performing bronchoscopy. This results in a significant number of negative bronchoscopes. Certain elements in the history and physical exam were more common in patients who were found to have an AFB. Our preliminary data suggest that chest CT scans may be useful to decrease the number of negative bronchoscopies.
PMID: 26988068 [PubMed - as supplied by publisher]
Release of the Inferior Crus in Antihelix Plasty.
Ann Otol Rhinol Laryngol. 2016 Mar 17;
Authors: Raunig H, Ofner M
Abstract
OBJECTIVE: Protruding ears with a hypoplastic antihelix often have poorly developed inferior crus. Publications on this topic until now have only dealt with absent inferior crus and have neglected its importance in everyday antihelix plasty. This article describes a new surgical technique to improve treatment of the antihelix.
METHODS: Patients with protruding upper third ears received either standard otoplasty with crus superior remodeling (ST) or the newly developed surgical procedure including crus inferior release (STI). To evaluate the results, a survey containing 10 questions about different outcome parameters was conducted with the patients. Each question was given a score ranging from 0 to 10, where 10 meant the best outcome and 0 the worst.
RESULTS: From January 2013 to March 2014, 216 patients underwent otoplasty, of which 99 completed the questionnaire. No differences could be found between ST and STI patients except for their duration of pain, which was significantly less in group STI. Overall, the scores from the questionnaire were 89.85 in ST and 92.35 in STI. Mean values for satisfaction were 9.33 in group ST and 9.56 in group STI.
CONCLUSION: When correcting the antihelix, the inferior crus must always be checked because the protruding upper third cannot be compensated only by overcorrecting the superior crus. It should be a matter of routine to recognize the degree of malformation and determine the best possible treatment. This novel technique is an additional valuable option in otoplasty to improve the upper third in a more natural way and create highly satisfactory results.
PMID: 26988067 [PubMed - as supplied by publisher]
[Clinical Aspects of Cochlear Implantation in Meniere's Disease and After Labyrinthectomy].
Laryngorhinootologie. 2016 Mar 18;
Authors: Lehner AA, Bonnet R, Linder TE
Abstract
Objective: Due to the natural aging and the loosened CI-implantation criteria more formerly operated Meniere's patients will be supplied with a cochlear implant. However, it raises the question whether an implantation in a previously treated ear is promising. Material and Methods: Based on 2 cases in which we have carried out a CI-implantation, one of them 10 years after transmastoidal labyrinthectomy, and based on the current literature we draw attention to problems and prospects of success. Discussion: Histological studies show only a small ossification of the cochlea after labyrinthectomy. Implanted Meniere's patients have a better speech intelligibility than other CI users. Attacks of rotatory vertigo with tinnitus and fluctuations of hearing after cochlear implantation in Meniere's patients are rare or they are too little described. Conclusion: There is a trend to perform a simultaneous labyrinthectomy and cochlea implantation in Meniere's patients with desabling vertigo which have not responded to drug treatment. A formerly performed transmastoidal labyrinthectomy is not a contraindication for a cochlear implantation.
PMID: 26990936 [PubMed - as supplied by publisher]
Coexistence of tinnitus and hyperacusis in individuals with auditory dys-synchrony: A single case study.
Intractable Rare Dis Res. 2016 Feb;5(1):50-5
Authors: Megha KN, Adithya S, Keerthana KP, Konadath S
Abstract
Certain clinical pathologies affecting the ear and hearing mechanism may co-exist. It is necessary to probe in detail into such conditions so that the pathophysiology is well understood. This research paper through a single case study tries to explain the probable pathophysiology behind coexistence of three different clinical conditions namely auditory dys-synchrony, hyperacusis and tinnitus. These conditions are common in the clinics, but the coexistence of all the three is rare and demands explanation beyond what is available in the literature. The assumed model highlights involvement of the outer hair cell's motor function in the cochlea along with the auditory central gain mechanism to explain possible pathophysiology behind coexistence of the three conditions. This model will provide insight into the probable link between the contribution of peripheral and central structures of hearing in generating tinnitus and hyperacusis in individuals having auditory dys-synchrony.
PMID: 26989651 [PubMed]
Clinical trial on tonal tinnitus with tailor-made notched music training.
BMC Neurol. 2016;16(1):38
Authors: Stein A, Wunderlich R, Lau P, Engell A, Wollbrink A, Shaykevich A, Kuhn JT, Holling H, Rudack C, Pantev C
Abstract
BACKGROUND: Tinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that removal of exactly these frequencies from a complex auditory stimulus will cause the brain to reorganize around tonotopic regions coding the tinnitus frequency through inhibition-induced plasticity. Based on this assumption, a novel treatment for tonal tinnitus - tailor-made notched music training (TMNMT) - has been introduced and was tested in this clinical trial.
METHODS: A randomized controlled trial in parallel group design was performed in a double-blinded manner. We included 100 participants with chronic, tonal tinnitus who listened to tailor-made notched music for two hours a day for three consecutive months. Our primary outcome measures were the Tinnitus Handicap Questionnaire and Visual Analog Scales measuring perceived tinnitus loudness, awareness, distress and handicap. Participants rated their tinnitus before and after the training as well as one month after cessation of the training.
RESULTS: While no effect was found for the primary outcome measures, tinnitus distress, as measured by the Tinnitus Questionnaire, a secondary outcome measure, developed differently in the two groups. The treatment group showed higher distress scores while the placebo group revealed lower distress scores after the training. However, this effect did not reach significance in post-hoc analysis and disappeared at follow-up measurements. At follow-up, tinnitus loudness in the treatment group was significantly reduced as compared to the control group. Post hoc analysis, accounting for low reliability scores in the Visual Analog Scales, showed a significant reduction of the overall Visual Analog Scale mean score in the treatment group even at the post measurement.
CONCLUSION: This is the first study on TMNMT that was planned and conducted following the CONSORT statement standards for clinical trials. The current work is one more step towards a final evaluation of TMNMT. Already after three months the effect of training with tailor-made notched music is observable in the most direct rating of tinnitus perception - the tinnitus loudness, while more global measures of tinnitus distress do not show relevant changes.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN04840953 ; Trial registration date: 17.07.2013.
PMID: 26987755 [PubMed - in process]
A stratified analysis of the perioperative outcome of 17,623 patients undergoing major head and neck cancer surgery in England over 10 years.
Clin Otolaryngol. 2016 Mar 15;
Authors: Nouraei S, Mace AD, Middleton SE, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke PM, Darzi A, Aylin P
Abstract
OBJECTIVES: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data.
DESIGN: A Hospital Episode Statistics N=near-all analysis.
SETTINGS: The English National Health Service.
MAIN OUTCOME MEASURES: Local audit data were used to assess health informatics data quality. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded.
RESULTS: Within local audit datasets, the accuracy of assigning cancer site and resection type were 92.3% and 94.2% respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17,623 cases between 2003-2012. There were 12,413 males and mean age at surgery was 63±12 years. The commonest cancer site strata were oral cavity (42%) and larynx-hypopharynx (32%). The commonest resection site was the larynx (n=4,217), and 13,211 and 11,841 patients had neck dissection and flap-based reconstruction respectively. There were prognostically-significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had more morbidities, lower socio-economic status, fewer primary resections, and a 6-fold increased risk of undergoing emergency major surgery. Mean length of stay was 25 days and each complication increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of 7 medical and 3 surgical complications were prognostic. At least one potentially-lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially-lethal complication was 1.1% and this increased to 6% with one potentially-lethal complication and to 15.1% if two potentially-lethal complications occurred in one patient. Complex oral-pharyngeal resections and pharyngolaryngectomies had the highest risks of complications and mortality.
CONCLUSION: Mortality following head and neck cancer surgery shows variation across different resection strata. We propose an Informatics-based Framework for Outcomes Surveillance (IFOS) in Head and Neck Surgery for perpetual quality assurance, using the local hospital coding data or its collated destination, the national administrative dataset. This article is protected by copyright. All rights reserved.
PMID: 26990866 [PubMed - as supplied by publisher]
Recent advances in robot-assisted head and neck surgery.
Int J Med Robot. 2016 Mar 16;
Authors: Friedrich DT, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ
Abstract
OBJECTIVE: This article reviews current clinical applications and experimental developments for robotic surgery in the head and neck with special focus on financial challenges, current clinical trials, and the controversial aspect of haptic and tactile feedback.
DATA SOURCES: Literature was screened using the pubmed library. Information on clinical trials was excerpted from the National Institute of Health database. Additional data on experimental developments were gathered by personal communication.
RESULTS: A steep increase in clinical applications for robotic surgery in the head and neck is determined as possible indications extend. Clinical trials are mostly non-randomized. A wide range of new robotic systems are expected to come into clinical use in the near future.
CONCLUSION: As head and neck surgeons become more familiar with robotic surgery some patients evidently benefit from new technologies. Increased competition between the systems will certainly drive technological improvement and decrease the financial burden. Copyright © 2016 John Wiley & Sons, Ltd.
PMID: 26990024 [PubMed - as supplied by publisher]
A Rare Case of Functioning Adrenocortical Oncocytoma Presenting as Cushing Syndrome.
Case Rep Surg. 2016;2016:8964070
Authors: Tartaglia N, Cianci P, Altamura A, Lizzi V, Vovola F, Fersini A, Ambrosi A, Neri V
Abstract
Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been reported in other sites including choroid plexus, respiratory tract, and larynx. Histologically, they are characterized by cells with eosinophilic granular cytoplasm and numerous packed mitochondria. We reported a case of a 44-year-old female who presented with Cushing syndrome for hypersecretion of cortisol due to adrenocortical oncocytoma. Magnetic resonance of abdomen revealed a right adrenal mass. Laparoscopic adrenalectomy was performed and the tumor was pathologically confirmed as benign adrenocortical oncocytoma. After surgical treatment, Cushing's syndrome resolved.
PMID: 26989553 [PubMed]
Prognostic factors for recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps.
Auris Nasus Larynx. 2016 Mar 14;
Authors: Nakayama T, Asaka D, Kanaya H, Kuboki A, Haruna SI
Abstract
OBJECTIVE: In this study, we aimed to clarify the prognostic factors affecting the ethmoid condition during a long-term follow-up after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
METHODS: Thirty-six patients with CRSwNP underwent surgery from December 2008 to February 2012. All surgeries were performed by one surgeon, and all patients were followed up for at least 2 years postoperatively. We investigated the association of postoperative endoscopic findings with clinical parameters, mucosal eosinophil count and mRNA expression of CCL11, IL-5, and IFN-gamma in nasal polyps.
RESULTS: Seventeen patients (47.2%) had severe mucosal edema, and the patency of each sinus was not confirmed during the >2-year follow-up. The mucosal eosinophil count and two eosinophil-associated factors, namely the CCL11 and IL-5 mRNA levels, were higher in the severe mucosal edema group than in the control group. The severe mucosal edema group was divided into two subgroups: the steroid-responsive and -resistant groups. Five patients (13.9%) had frank polyp formation because the oral steroids were less effective. The mucosal eosinophil count was significantly different among the four groups, including the control group (p=0.001); however, the CCL11, IL-5, and IFN-gamma mRNA levels were not significantly different. Although the IL-5 mRNA level was not significantly different among the four groups, it tended to increase when the sinus condition worsened. In the severe mucosal edema group, a higher IL-5 mRNA level was associated with earlier severe mucosal edema in the ethmoid cavity.
CONCLUSION: The IL-5 mRNA level is associated with the time of severe edema formation in the ethmoid cavity. This finding permits early intervention on the postoperative course and would prevent polyp recurrence.
PMID: 26987817 [PubMed - as supplied by publisher]
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[Clinical Aspects of Cochlear Implantation in Meniere's Disease and After Labyrinthectomy].
Laryngorhinootologie. 2016 Mar 18;
Authors: Lehner AA, Bonnet R, Linder TE
Abstract
Objective: Due to the natural aging and the loosened CI-implantation criteria more formerly operated Meniere's patients will be supplied with a cochlear implant. However, it raises the question whether an implantation in a previously treated ear is promising. Material and Methods: Based on 2 cases in which we have carried out a CI-implantation, one of them 10 years after transmastoidal labyrinthectomy, and based on the current literature we draw attention to problems and prospects of success. Discussion: Histological studies show only a small ossification of the cochlea after labyrinthectomy. Implanted Meniere's patients have a better speech intelligibility than other CI users. Attacks of rotatory vertigo with tinnitus and fluctuations of hearing after cochlear implantation in Meniere's patients are rare or they are too little described. Conclusion: There is a trend to perform a simultaneous labyrinthectomy and cochlea implantation in Meniere's patients with desabling vertigo which have not responded to drug treatment. A formerly performed transmastoidal labyrinthectomy is not a contraindication for a cochlear implantation.
PMID: 26990936 [PubMed - as supplied by publisher]
[Speech Ability and Psychological Outcome After Treatment of Oral Cancer].
Laryngorhinootologie. 2016 Mar 18;
Authors: Böhm N, Knipfer C, Maier A, Bocklet T, Rohde M, Neukam FW, Stelzle F, Schuster M
Abstract
Background: In recent years interactions between surgical treatment of oral carcinoma and incidence of anxiety or depression have become a subject of discussions. This prospective study is a comparison between the extent of loss of speech intelligibility and presence of depressive symptoms or anxiety as a result of oral carcinoma. Material and Methods: One year after surgical therapy for oral carcinoma, 90 patients of an average age of 60±12 years were examined. Their speech intelligibility degree was measured using standardized automatic speech recognition (word recognition rate, WR). Symptoms of anxiety and depression were detected by use of HAD-Scales (HADS). Next to the relationship between WR and HADS other influential variables related to WR and HADS were statistically evaluated. Results: The WR average was 53.2±17.2. Female WR was better than male. The difference between tumor classifications T1 and T4 compared to the WR reached statistical significance. Significant differences were detected between WR and "tumor localization", "graft donor site", "graft morphology", "tongue motility", and "tracheostoma" groups. There was a relationship between tongue motility and graft morphology, graft donor site and tumor localization. HAD-Scores in the mean were elevated: HADS-Total=43.3%, HADS-A=43.3% und HADS-D= 51.1%. WR correlates with HADS-D-Subscale, but not with HADS-A-Subscale. Conclusion: Communication disorders as a result of neoplasmic orofacial surgery may be related to extent of the treatment and to affective impairments. This should receive attention in the concept of rehabilitation.
PMID: 26990935 [PubMed - as supplied by publisher]
[Hearing Loss in a Blind Youth].
Laryngorhinootologie. 2016 Mar 18;
Authors: Nießen A, Pflug C
PMID: 26990934 [PubMed - as supplied by publisher]
[Swallowing Disorders].
Laryngorhinootologie. 2016 Mar;95(3):205-224
Authors: Scharitzer M, Pokieser P
Abstract
Swallowing disorders are a common disease in all ages. The spectrum of diseases in patients with swallowing disorders has significantly changed in the last decades. Often complexe clinical pictures require a multidisciplinary approach including various different professionals. Videofluoroscopy is the method of choice for evaluation of the entire swallowing tract within one investigation. Functional as well as morphological changes can be diagnosed and as a therapeutic study, it helps guide decisions regarding further swallow therapy based on those findings.
PMID: 26990835 [PubMed - as supplied by publisher]
RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study.
Int Forum Allergy Rhinol. 2016 Mar 14;
Authors: Forwith KD, Han JK, Stolovitzky JP, Yen DM, Chandra RK, Karanfilov B, E Matheny K, Stambaugh JW, K Gawlicka A
Abstract
BACKGROUND: Patients with recurrent sinonasal polyposis after endoscopic sinus surgery (ESS) have limited treatment options. Safety and efficacy were previously reported for a bioabsorbable sinus implant that elutes mometasone furoate for 3 months. Here we summarize longer-term outcomes.
METHODS: A randomized, controlled, blinded study with 100 chronic rhinosinusitis with nasal polyps (CRSwNP) patients who failed medical treatment and were considered candidates for revision ESS. Treated patients (n = 57) underwent in-office implant placement. Control patients (n = 43) underwent a sham procedure. Endoscopic grading at 3 months by clinicians was corroborated by an independent review of randomized videoendoscopies by a panel of 3 sinus surgeons. Six-month follow-up included endoscopic grading and patient-reported outcomes.
RESULTS: At 6 months, treated patients experienced significant improvement in Nasal Obstruction Symptom Evaluation (NOSE) score (p = 0.021) and >2-fold improvement in mean nasal obstruction/congestion score (-1.06 ± 1.4 vs -0.44 ± 1.4; p = 0.124). Endoscopically, treated patients experienced significant reduction in ethmoid sinus obstruction (p < 0.001) and bilateral polyp grade (p = 0.018) compared to controls. Panel review confirmed a significant reduction in ethmoid sinus obstruction (p = 0.010) and 2-fold improvement in bilateral polyp grade (p = 0.099), which reached statistical significance (p = 0.049) in a subset of 67 patients with baseline polyp burden ≥2 bilaterally. At 6 months, control patients were at 3.6 times higher risk of remaining indicated for ESS than treated patients.
CONCLUSION: The symptomatic and endoscopic improvements observed confirm the efficacy of the steroid-eluting implant for in-office treatment of CRSwNP after ESS. These longer-term 6-month study results demonstrate that the steroid-eluting implant represents a durable, safe, and effective treatment strategy for this patient population.
PMID: 26992115 [PubMed - as supplied by publisher]
The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS).
Int Forum Allergy Rhinol. 2016 Mar 14;
Authors: Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, Senior BA, Smith TL, Hwang PH, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Goessler U, Khan M, Bernal-Sprekelsen M, Kuehnel T, Psaltis A
Abstract
The frontal recess and frontal sinus anatomy can vary from simple to complex. The variations in the anatomy of the frontal recess and frontal sinus are considerable but almost all variations can be classified if the various cell patterns are analyzed. This consensus document was developed to improve the ability of the surgeon to understand these possible variations, plan the surgery, and communicate these complexities when teaching or reporting outcomes. Once the surgeon understands the anatomical pattern of the frontal sinus and recess cells, the extent of surgery can be planned. This document presents a classification of the extent of surgery based on the anatomical classification.
PMID: 26991922 [PubMed - as supplied by publisher]
Clinical implications of mucosal remodeling from chronic rhinosinusitis.
Int Forum Allergy Rhinol. 2016 Mar 17;
Authors: Do TQ, Barham HP, Earls P, Sacks R, Christensen JM, Rimmer J, Harvey RJ
Abstract
BACKGROUND: Prognostic implications of mucosal remodeling in chronic rhinosinusitis (CRS) remain unclear. Remodeling of respiratory mucosa in asthma is associated with greater medication use and decreased function. This study investigates the implications of mucosal remodeling on long-term clinical outcomes in patients with CRS.
METHODS: A case-control study of adult patients with CRS undergoing endoscopic sinus surgery (ESS) was performed. Mucosal remodeling was defined by squamous metaplasia, subepithelial fibrosis, and/or basement membrane thickening. The presence of remodeling changes were assessed relative to clinical and treatment outcomes at a minimum of 12 months postoperatively. Clinical outcomes were assessed at baseline and 12 months using a Nasal Symptom Score (NSS) and 22-item Sino-Nasal Outcome Test (SNOT-22). Treatment outcomes were assessed by oral corticosteroid usage (burst/continuous), topical corticosteroid irrigation frequency, and further surgical intervention.
RESULTS: A total of 110 patients (48.73 ± 14.75 years, 48.2% female) were assessed. Significant improvements where seen for the entire population, in both NSS (2.64 ± 1.06 to 1.34 ± 1.08, p < 0.001) and SNOT-22 (2.05 ± 0.96 to 1.06 ± 0.79, p < 0.001). Patients with remodeling (n = 88) were younger (47.2 ± 14.8 vs 54.7 ± 13.5 years, p = 0.03), but had similar symptom scores. Remodeling was seen in CRS with nasal polyposis (CRSwNP) (54.5%) and eosinophilic chronic rhinosinusitis (eCRS) (59.8%). Symptom improvement at 12 months was similar between remodeled and non-remodeled groups (NSS: Δ1.34 ± 1.20 vs Δ1.12 ± 1.31, p = 0.395; SNOT-22: Δ1.05 ± 0.91 vs Δ0.73 ± 0.95, p = 0.124); however, patients with remodeling had greater corticosteroid irrigation frequency (64.0% vs 31.6% daily use, Kendall's tau-b p = 0.004).
CONCLUSION: Established mucosal remodeling predicts a greater reliance on topical therapies to reach similar clinical endpoints as those without remodeling.
PMID: 26990243 [PubMed - as supplied by publisher]
Recent advances in robot-assisted head and neck surgery.
Int J Med Robot. 2016 Mar 16;
Authors: Friedrich DT, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ
Abstract
OBJECTIVE: This article reviews current clinical applications and experimental developments for robotic surgery in the head and neck with special focus on financial challenges, current clinical trials, and the controversial aspect of haptic and tactile feedback.
DATA SOURCES: Literature was screened using the pubmed library. Information on clinical trials was excerpted from the National Institute of Health database. Additional data on experimental developments were gathered by personal communication.
RESULTS: A steep increase in clinical applications for robotic surgery in the head and neck is determined as possible indications extend. Clinical trials are mostly non-randomized. A wide range of new robotic systems are expected to come into clinical use in the near future.
CONCLUSION: As head and neck surgeons become more familiar with robotic surgery some patients evidently benefit from new technologies. Increased competition between the systems will certainly drive technological improvement and decrease the financial burden. Copyright © 2016 John Wiley & Sons, Ltd.
PMID: 26990024 [PubMed - as supplied by publisher]
Spontaneous Transethmoidal Meningoceles in Adults: Case Series with Emphasis on Surgical Management.
ScientificWorldJournal. 2016;2016:3238297
Authors: Ziade G, Hamdan AL, Homsi MT, Kazan I, Hadi U
Abstract
Background. Spontaneous onset transethmoidal meningocele is a rare entity among the adult population. Methods. A retrospective chart review was performed and cases of adults diagnosed with spontaneous transethmoidal meningoceles from November 2000 till February 2014 were reported. Data collected included demographics, clinical presentation, diagnostic modalities, and results. Intraoperative findings, the type of surgical reconstruction performed, and the percentage of recurrence, if present, were also reported. Results. Ten cases of spontaneous transethmoidal meningoceles in adults were diagnosed. Eight were females and two males with a mean age of 47.5 years. All patients presented with CSF leakage with or without meningitis. They underwent a reconstruction of the base of skull defect using the temporalis fascia graft in addition to fibrin glue (Tissucol) and Surgicel (Ethicon). In two cases with a larger defect, a piece of septal bone and turbinate mucosa were applied achieving a watertight seal in all cases. Conclusion. Spontaneous transethmoidal meningocele in adults is a rare condition. It usually presents with clear rhinorrhea with or without meningitis and an endoscopic multilayer reconstruction is advocated for treatment of such conditions.
PMID: 26989762 [PubMed - in process]
Spectrum of Clinical and Associated MR Imaging Findings in Children with Olfactory Anomalies.
AJNR Am J Neuroradiol. 2016 Mar 17;
Authors: Booth TN, Rollins NK
Abstract
BACKGROUND AND PURPOSE: The olfactory apparatus, consisting of the bulb and tract, is readily identifiable on MR imaging. Anomalous development of the olfactory apparatus may be the harbinger of anomalies of the secondary olfactory cortex and associated structures. We report a large single-site series of associated MR imaging findings in patients with olfactory anomalies.
MATERIALS AND METHODS: A retrospective search of radiologic reports (2010 through 2014) was performed by using the keyword "olfactory"; MR imaging studies were reviewed for olfactory anomalies and intracranial and skull base malformations. Medical records were reviewed for clinical symptoms, neuroendocrine dysfunction, syndromic associations, and genetics.
RESULTS: We identified 41 patients with olfactory anomalies (range, 0.03-18 years of age; M/F ratio, 19:22); olfactory anomalies were bilateral in 31 of 41 patients (76%) and absent olfactory bulbs and olfactory tracts were found in 56 of 82 (68%). Developmental delay was found in 24 (59%), and seizures, in 14 (34%). Pituitary dysfunction was present in 14 (34%), 8 had panhypopituitarism, and 2 had isolated hypogonadotropic hypogonadism. CNS anomalies, seen in 95% of patients, included hippocampal dysplasia in 26, cortical malformations in 15, malformed corpus callosum in 10, and optic pathway hypoplasia in 12. Infratentorial anomalies were seen in 15 (37%) patients and included an abnormal brain stem in 9 and an abnormal cerebellum in 3. Four patients had an abnormal membranous labyrinth. Genetic testing was performed in 23 (56%) and findings were abnormal in 11 (48%).
CONCLUSIONS: Olfactory anomalies should prompt careful screening of the brain, skull base, and the pituitary gland for additional anomalies. Genetic testing should be considered.
PMID: 26988815 [PubMed - as supplied by publisher]
A Cost Effective Delivery System for FloSeal® During Endoscopic and Microscopic Brain Surgery: Technical Note.
World Neurosurg. 2016 Mar 14;
Authors: Brand Y, Narayanan V, Prepageran N, Waran V
Abstract
OBJECTIVE: In this technical note we share our experience with a new delivery system for the flowable, haemostatic, matrix, FloSeal® (Baxter, Deerfield, IL, USA), in endoscopic and microscopic skull base surgery.
METHODS: We prospectively analyzed the use of FloSeal(®) with a hemostatic delivery system in transnasal endoscopic and microscopic skull base procedures performed at the authors' institution from 1.1.2015 to 30.6.15. In all cases the number of aliquots were noted for the entire operation and also the total number of FloSeal(®) ampules of 5 ml was recorded.
RESULTS: Our device allowed controlled application of small amount (0.5 - 1 ml) of FloSeal(®) to the site of bleeding. This controlled application resulted not only in increased visibility during its application, but also reduced the amount of FloSeal(®) required during the procedure. We were able to use 5-10 application per 5 ml ampule of FloSeal(®) within an individual procedure. No procedure required more than one 5 ml ampule of FloSeal(®). Therefore, the use of our device results in a reduction of costs. Prior to the use of our device, we were often only able to use the material of one vial of 5 ml for one or two applications - especially in transnasal endoscopic procedures when working along a deep corridor.
CONCLUSIONS: Our results indicate that our delivery device of FlowSeal(®) can effectively control hemostasis by applying small amounts of FlowSeal(®) to the site of bleeding. This results in increased visibility during hemostasis and reduction of cost.
PMID: 26987637 [PubMed - as supplied by publisher]
Usefulness of extradural optic nerve decompression via trans-superior orbital fissure approach for treatment of traumatic optic nerve injury: important surgical procedures and techniques from experience with 8 consecutive patients.
World Neurosurg. 2016 Mar 14;
Authors: Otani N, Wada K, Fujii K, Toyooka T, Kumagai K, Ueno H, Tomura S, Tomiyama A, Nakao Y, Yamamoto T, Mori K
PMID: 26987635 [PubMed - as supplied by publisher]
The inferolateral transorbital endoscopic approach: a preclinical anatomical study.
World Neurosurg. 2016 Mar 14;
Authors: Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Tschabitscher M, Rodella LF, Nicolai P
Abstract
BACKGROUND: In recent years, transorbital endoscopic approaches (TEA) are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomical landmarks, and target anatomical areas.
METHODS: Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia. Step-by-step dissection of ILTEA was performed to identify the main anatomical landmarks and corridors. Skin incision, dural incision, and boundaries of craniectomy were measured. Neuronavigation was used to check landmarks, track boundaries of surgical volumes, and measure orbital dislocation.
RESULTS: The study on 14 ILTEAs defined one anatomical area (called "waterline door"), which guides to 4 corridors: Meckel's cave corridor, carotid foramen corridor, petrous corridor, and transdural middle fossa corridor. Crucial anatomical landmarks were identified and analyzed. Orbital dislocation was less than 10 mm.
CONCLUSIONS: ILTEA provides the surgeon with a direct route to the region of the "waterline door", lateral areas of the ventral skull base, and middle cranial fossa. Moreover, it allows an optimal view of the intra- and extra-cranial portions of the maxillary and mandibular nerves. Further anatomical and clinical studies are needed to validate ILTEA in surgical practice.
PMID: 26987633 [PubMed - as supplied by publisher]
Precaruncular approach to the medial orbit & landmarks for anterior ethmoidal artery ligation: A cadaveric study.
Clin Otolaryngol. 2016 Mar 14;
Authors: Cornelis MM, Lubbe DE
Abstract
OBJECTIVE: In epistaxis and skull base surgery, the anterior ethmoidal artery sometimes needs to be ligated. We describe a novel, quick and scar-free surgical technique to ligate this artery with salient landmarks allowing rapid identification.
PATIENTS AND METHODS: Twenty medial orbital walls from 10 randomly selected fresh-frozen, non-formalinized cadaver heads were examined. Dissection was performed by a precaruncular external approach to expose the AEA in all cases.
RESULTS: The Horner's muscle and nasion, two salient landmarks, have been identified for use during the precaruncular approach.
DISCUSSION/CONCLUSION: The precaruncular approach is a novel combined open and endoscopic surgical approach to the anterior ethmoidal artery. It is a simple, quick and scar-free technique. The identification of the artery is easy when using the two anatomic landmarks we describe in our study i.e. Horner's muscle and the nasion. This article is protected by copyright. All rights reserved.
PMID: 26987555 [PubMed - as supplied by publisher]
Temporal bone squamous cell carcinoma - Penang experience.
Med J Malaysia. 2015 Dec;70(6):367-8
Authors: Ng SY, Pua KC, Zahirrudin Z
Abstract
Temporal bone squamous cell carcinoma (TBSCC) is rare and poses difficulties in diagnosing, staging and management. We describe a case series with six patients who were diagnosed TBSCC, from January 2009 to June 2014, with median age of 62 years old. All patients presented with blood-stain discharge and external auditory canal mass, showing that these findings should highly alert the diagnosis of TBSCC. Three patients staged T3 and another three with T4 disease. High-resolution CT (HRCT) temporal findings were noted to be different from intraoperative findings and therefore we conclude that MRI should be done to look for middle ear involvement or other soft tissue invasion for more accurate staging. Lateral temporal bone resection (LTBR) and parotidectomy was done for four patients with or without neck dissection. Patients with positive margin, perineural invasion or parotid and glenoid involvement carry poorer prognosis and postoperative radiotherapy may improve the survival rate. One patient had successful tumor resection via piecemeal removal approach in contrast with the recommended en bloc resection shows that with negative margin achieved, piecemeal removal approach can be a good option for patients with T2-3 disease. In general, T4 tumor has dismal outcome regardless of surgery or radiotherapy given.
PMID: 26988214 [PubMed - in process]
[Clinical Aspects of Cochlear Implantation in Meniere's Disease and After Labyrinthectomy].
Laryngorhinootologie. 2016 Mar 18;
Authors: Lehner AA, Bonnet R, Linder TE
Abstract
Objective: Due to the natural aging and the loosened CI-implantation criteria more formerly operated Meniere's patients will be supplied with a cochlear implant. However, it raises the question whether an implantation in a previously treated ear is promising. Material and Methods: Based on 2 cases in which we have carried out a CI-implantation, one of them 10 years after transmastoidal labyrinthectomy, and based on the current literature we draw attention to problems and prospects of success. Discussion: Histological studies show only a small ossification of the cochlea after labyrinthectomy. Implanted Meniere's patients have a better speech intelligibility than other CI users. Attacks of rotatory vertigo with tinnitus and fluctuations of hearing after cochlear implantation in Meniere's patients are rare or they are too little described. Conclusion: There is a trend to perform a simultaneous labyrinthectomy and cochlea implantation in Meniere's patients with desabling vertigo which have not responded to drug treatment. A formerly performed transmastoidal labyrinthectomy is not a contraindication for a cochlear implantation.
PMID: 26990936 [PubMed - as supplied by publisher]
Short-Term Side Effects after Radioiodine Treatment in Patients with Differentiated Thyroid Cancer.
Biomed Res Int. 2016;2016:4376720
Authors: Lu L, Shan F, Li W, Lu H
Abstract
Objectives. I-131 therapy for differentiated thyroid cancer (DTC) could induce adverse effects. The purpose of this study was to report and analyze symptoms after I-131 treatment within the hospitalization and present relevant medical intervention. Methods. I-131 doses ranging from 3.7 to 9.25 GBq (100-250 mCi) were administrated for thyroid remnant ablation or treating DTC metastases. 117 patients with DTC for I-131 therapy were monitored through the video and intercommunicating with standardized questionnaire at different time points after I-131 oral administration. Adverse effects were recorded and relevant clinical factors were analyzed. Results. Among all the 117 patients, 55 cases complained of neck's pain or swelling and 79 cases presented with gastrointestinal symptoms. Pain or swelling of salivary gland occurred in 15 patients, headache and vertigo in 10, insomnia in 9, vocal cord paralysis in 6, fatigue or general malaise in 6, and foreign body sensation in 5. Body numbness and urinary symptoms were observed in only 1 case, respectively. Those side effects were related with sex, pre-I-131 treatment TSH levels, frequency of I-131 therapy, and lymph node metastases. Conclusions. Short-term side effects after I-131 therapy for DTC patients varied individually; severe symptoms were not uncommon but generally did not need emergent medical intervention.
PMID: 26989683 [PubMed - in process]
How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations.
Acta Otolaryngol. 2016 Mar 18;:1-6
Authors: Harris JP, Wong YT, Yang TH, Miller M
Abstract
Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).
PMID: 26988908 [PubMed - as supplied by publisher]
A case of Behçet's disease possibly triggered by β-glucan.
Postepy Dermatol Alergol. 2016 Feb;33(1):73-4
Authors: Gulsel BA, Irfan KT, Ulas G, Umit T, Kiymet B, Guliz I
PMID: 26985185 [PubMed]
A case of papular elastorrhexis.
Postepy Dermatol Alergol. 2016 Feb;33(1):70-2
Authors: Gönül M, Bilen G, Gökce A, Alper M
PMID: 26985184 [PubMed]
The flare-up phenomenon: recurrence of distant dermatitis during patch testing.
Postepy Dermatol Alergol. 2016 Feb;33(1):68-9
Authors: Obtułowicz A, Nowak-Ślusarczyk M, Pirowska M, Lipko-Godlewska S, Wojas-Pelc A
PMID: 26985183 [PubMed]
Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages.
Postepy Dermatol Alergol. 2016 Feb;33(1):63-7
Authors: Perkowska J, Kruszewski J, Gutkowski P, Chciałowski A, Kłos K
Abstract
INTRODUCTION: Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life.
AIM: To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life.
MATERIAL AND METHODS: Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out.
RESULTS: In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs.
CONCLUSIONS: The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.
PMID: 26985182 [PubMed]
Coexistence of 2282del4 FLG gene mutation and IL-18 -137G/C gene polymorphism enhances the risk of atopic dermatitis.
Postepy Dermatol Alergol. 2016 Feb;33(1):57-62
Authors: Trzeciak M, Gleń J, Rębała K, Bandurski T, Sikorska M, Nowicki R
Abstract
INTRODUCTION: Atopic dermatitis (AD) pathogenesis appears in the context of the correlation between cornified envelope proteins and immunological factors.
AIM: To estimate the association between FLG R501X and 2282del4 gene mutations, -137 G/C IL-18 and -1112 C/T IL-13 gene polymorphisms and their influence on AD course and the risk in the Polish population.
MATERIAL AND METHODS: One hundred and fifty-two AD patients and 123 healthy volunteers were included into the study. Amplification refractory mutation system - polymerase chain reaction method was used.
RESULTS: 2282del4 FLG mutation, predominant (p = 0.04) in Polish AD patients, enhanced the risk of AD (OR = 2.35; p = 0.01) and was associated with itch (p = 0.023). GG genotype of IL-18 was prevailing in AD (p < 0.0001), associated with elevated IgE levels (p = 0.00074) and pruritus (p < 0.0001). GG genotype and G-allele in -137 position of IL-18 increased AD risk (OR = 5.4; p = 0.0001, respectively, OR = 5.3; p = 0.000029). -1112 C/T polymorphism of IL-13 was associated with elevated IgE levels (p = 0.00049), pruritus (p = 0.0005), SCORAD score (p = 0.02), concomitant asthma (p = 0.0087) and AD risk (OR = 2.02; p = 0.012). Coexistence of 2282del4 or R501X FLG gene mutation with GG genotype of IL-18 was associated with a 6-fold higher risk of AD (OR = 5.8; p = 0.00013), contrary to combined occurrence of FLG mutations with T-allele in -1112 position of IL-13 gene (OR = 0.12; p = 0.1).
CONCLUSIONS: 2282del4 FLG mutation similarly to GG genotype and G-allele in -137 position of IL-18 gene enhance the risk of AD in the Polish population. Coexistence of FLG mutations with GG genotype of IL-18 may be helpful to estimate chances of AD development.
PMID: 26985181 [PubMed]
Skin toxicity in BRAF(V600) mutated metastatic cutaneous melanoma patients treated with vemurafenib.
Postepy Dermatol Alergol. 2016 Feb;33(1):52-6
Authors: Nowara E, Huszno J, Slomian G, Nieckula J
Abstract
INTRODUCTION: The use of orally available BRAF kinase inhibitor - vemurafenib is associated with numerous adverse skin reactions.
AIM: To assess the safety and early side effects of vemurafenib treatment in the unselected group of patients treated at the outpatient clinic, in particular the assessment of the incidence of skin cancer.
MATERIAL AND METHODS: We carried out a systematic study of patients (pts) treated with vemurafenib. Skin toxicity during vemurafenib therapy was analyzed. Toxicity was determined on the basis of the toxicity scale CTCAE, version 4.0.
RESULTS: The most common cutaneous side effects were hyperkeratotic perifollicular rash (69%) and photosensitivity (15%). Skin rash developed more frequently in the first month of treatment. Squamous cell carcinoma occurred in 38% of patients. Patients with skin cancer development during vemurafenib therapy had non-significantly longer overall survival (OS) than patients without skin cancer, p = 0.4. Skin cancer developed more often in women than in men (60% vs. 25%), p = 0.249. It was detected only in patients with normal weight compared to overweight patients (55% vs. 0), p = 0.09. The median OS was 26 months and median OS from the time of distant metastases diagnosis was 9.8 months. In patients with a low body mass index, shorter OS was observed, p = 0.09.
CONCLUSIONS: The incidence of squamous cell carcinoma was high (38%). This study has many limitations mostly due to a small group of patients. That is why the results should be taken into consideration with caution. The proper symptomatic treatment in cooperation with dermatologists allows to continue the vemurafenib therapy.
PMID: 26985180 [PubMed]
Evaluation of serum concentrations of the selected cytokines in patients with localized scleroderma.
Postepy Dermatol Alergol. 2016 Feb;33(1):47-51
Authors: Budzyńska-Włodarczyk J, Michalska-Jakubus MM, Kowal M, Krasowska D
Abstract
INTRODUCTION: Localized scleroderma is an autoimmune disease primarily affecting the skin. The cause of disease remains unexplained although environmental factors are implicated, which are likely to be responsible for activation of the endothelium and subsequent inflammation leading to excessive synthesis of collagen and extracellular matrix components.
AIM: To determine concentrations of interleukin (IL)-27, transforming growth factor (TGF)-β1, TGF-β2, IL-6, and sIL-6R in patients with localized scleroderma compared to controls and to assess the relations between their levels and laboratory markers.
MATERIAL AND METHODS: The study encompassed 17 females with localized scleroderma (aged 25-67). The control group consisted of 30 age-matched healthy women. The blood was sampled from the basilic vein. Serum levels of cytokines were determined using ELISA.
RESULTS: The TGF-β2 levels were found to be significantly lower in patients with localized scleroderma compared to controls. Concentrations of TGF-β1 were decreased in scleroderma patients when compared to controls but without statistical significance. There were no significant differences in serum IL-6, sIL-6R and IL-27 levels between patients and the control group; however, we found a significant positive correlation between the level of sIL-6 and ESR among subjects with localized scleroderma.
CONCLUSIONS: The findings of decreased serum levels of TGF-β1 and TGF-β2 in patients with localized scleroderma demonstrate a possible association of these cytokines with pathogenesis of the disease. The results suggest also that sIL-6R is likely to be involved in inflammation in patients with localized scleroderma.
PMID: 26985179 [PubMed]
Clinicopathological analysis of recurrent basal cell carcinoma of the eyelid.
Postepy Dermatol Alergol. 2016 Feb;33(1):42-6
Authors: Iljin A, Zieliński T, Antoszewski B, Sporny S
Abstract
INTRODUCTION: Basal cell carcinoma (BCC) is the most common malignant neoplasm of the eyelids and surrounding structures, usually developing in the area of the lower lid and medial canthus. Invasive forms of BCC are connected with a high risk of recurrence, often due to incomplete excision of these lesions.
AIM: Clinical and pathological analysis of recurrent BCCs of the eyelids and surrounding structures.
MATERIAL AND METHODS: We present clinical and pathological analysis including immunohistochemical reaction to Ki-67 antigen of 19 patients (11 women, 8 men) operated for recurrent BCCs of the eyelids in 2000-2012.
RESULTS: In most cases, recurrences were present on the lower lid and in the medial canthus. In 15 patients the histopathological type did not change and in 4 cases it transformed into more invasive forms. The values of Ki-67 index for primary BCCs ranged between 1% and 20%, and for relapsing lesions between 11% and 48%.
CONCLUSIONS: Proper clinical and pathological evaluation to determine the risk of relapse in BCCs of the eyelids and surrounding structures should include the analysis of prognostic factors, in particular location and size, histopathological type and radicalness of surgical treatment of primary BCCs. Clinical and pathological analysis of patients with recurrent BCC of the eyelids and surrounding structures should be combined with the evaluation of proliferation index Ki-67, which is essential for prognosis and choice of the appropriate therapeutic method.
PMID: 26985178 [PubMed]
The frequency of polymorphic variants of filaggrin gene and clinical atopic dermatitis.
Postepy Dermatol Alergol. 2016 Feb;33(1):37-41
Authors: Filipowska-Grońska A, Weryńska-Kalemba M, Bożek A, Filipowska B, Żebracka-Gala J, Rusinek D, Kula D, Jarząb J
Abstract
INTRODUCTION: As far as pathogenesis of the atopic dermatitis (AD) is concerned, the roles of an impaired epidermal barrier and cornified cell envelope are widely emphasized.
AIM: The assessment of mutations of the filaggrin gene and their connection with the clinical picture of AD as well as selected allergological and environmental indicators.
MATERIAL AND METHODS: 105 patients with diagnosed AD on the basis of diagnostic criteria were included. For every patient of the examined group, quantitative determination of the total concentration of IgE and the concentration of IgE antibodies to selected allergens were examined. For all patients, studies were performed by means of analysis of two genomic gene variants of profilaggrin (FLG) - R501X and 2282del4.
RESULTS: Loss-of-function mutations in the filaggrin gene were shown in 12 (11.4%) patients in the examined group. All patients in the study group who developed one of the tested loss-of-function mutations in the filaggrin gene demonstrated an extrinsic, allergic form of atopic dermatitis. A significant association (p = 0.0002) between the presence of one of the tested loss-of-function mutations in the filaggrin gene and elevated levels of total concentration of immunoglobulin E was shown.
CONCLUSIONS: Patients with AD of null mutations in the filaggrin gene demonstrate a relationship with the total and specific concentration of immunoglobulin E, specifically higher concentrations of IgE against aeroallergens and alimentary allergens as well as elevated levels of total immunoglobulin E.
PMID: 26985177 [PubMed]
A study of the activity and effectiveness of recombinant fibroblast growth factor (Q40P/S47I/H93G rFGF-1) in anti-aging treatment.
Postepy Dermatol Alergol. 2016 Feb;33(1):28-36
Authors: Żerańska J, Pasikowska M, Szczepanik B, Mlosek K, Malinowska S, Dębowska RM, Eris I
Abstract
INTRODUCTION: Fibroblast growth factor 1 (FGF-1) is a powerful mitogen involved in the stimulation of DNA synthesis and the proliferation of a wide variety of cell types. Fibroblast growth factor 1 was genetically modified to improve its thermal stability and resistance to protease degradation without losing its biological activity.
AIM: To study the impact of Q40P/S47I/H93G rFGF-1 on skin cells, its penetration through the skin and the evaluation of the rFGF-1-cosmetic product properties.
MATERIAL AND METHODS: In vitro studies included the examination of primary fibroblast and keratinocyte viability after the incubation with rFGF-1. The penetration abilities of rFGF-1 in various formulations and carrier systems were examined ex vivo by the Raman spectroscopy. In vivo studies - HF Ultrasound and 3D Imaging System - were used to evaluate the anti-aging properties of creams containing rFGF-1.
RESULTS: In vitro studies demonstrated that rFGF-1 strongly enhanced the viability of the treated cells. The Raman Spectroscopy analysis indicated that rFGF-1 encapsulated in lipid spheres penetrate through the stratum corneum to the depth of 60 µm, and added to the o/w formulation - could penetrate to a depth of 90 µm. The results obtained from Primos revealed the reduction of the volume and the depth of the wrinkles. Changes in the skin structure in the analyzed areas were evaluated by HF Ultrasonography.
CONCLUSIONS: Recombinant FGF-1 strongly stimulated fibroblast and keratinocyte proliferation. However, the transition of this protein through the SC required an appropriate carrier system - lipid spheres. All tests - in vitro, ex vivo and in vivo - have proved that rFGF-1 is a substance with a potentially wide spectrum of use.
PMID: 26985176 [PubMed]
Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome.
Postepy Dermatol Alergol. 2016 Feb;33(1):23-7
Authors: Błochowiak K, Olewicz-Gawlik A, Polańska A, Nowak-Gabryel M, Kocięcki J, Witmanowski H, Sokalski J
Abstract
INTRODUCTION: One of the most important symptoms of Sjögren syndrome is xerostomia. The oral cavity deprived of saliva and its natural lubricative, protective and antibacterial properties is prone to a number of unfavourable consequences.
AIM: To present the most important lesions on the oral mucosa in primary and secondary Sjögren syndrome and in dry mouth syndrome.
MATERIAL AND METHODS: The study group comprised 55 patients including 52 women and 3 men aged 20-72 years (average: 28.25 years).
RESULTS: Basing on the accepted criteria, primary Sjögren syndrome was diagnosed in 22 (40%) patients, secondary Sjögren syndrome in 18 (32.7%) patients, and dry mouth syndrome in 15 (27.27%) patients. The physical examination and the examination of the mouth were performed and history was elicited from every patient.
CONCLUSIONS: The most common pathologies appearing on the oral mucosa in primary and secondary Sjögren syndrome are angular cheilitis, cheilitis, increased lip dryness as well as non-specific ulcerations, aphthae and aphthoid conditions.
PMID: 26985175 [PubMed]
